What is Adrenalectomy? Purpose, Procedure & Recovery

Adrenalectomy is a surgical procedure to remove one or both of your adrenal glands. These small, triangular-shaped glands sit on top of each kidney and produce important hormones that help regulate your blood pressure, metabolism, and stress response. When these glands develop tumors or produce too many hormones, surgery may be the best way to restore your health and prevent complications.

What is adrenalectomy?

Adrenalectomy means surgical removal of your adrenal glands. Your surgeon can remove just one gland (unilateral adrenalectomy) or both glands (bilateral adrenalectomy), depending on your specific condition. The procedure helps treat various adrenal disorders that can't be managed with medication alone.

Your adrenal glands are about the size of a walnut and weigh roughly 4-5 grams each. They produce essential hormones like cortisol, aldosterone, and adrenaline that keep your body functioning properly. When these glands become diseased or overactive, removing them can be life-saving.

Why is adrenalectomy done?

Adrenalectomy becomes necessary when your adrenal glands develop serious problems that threaten your health. The most common reason is to remove tumors, whether they're cancerous or benign but causing harmful hormone overproduction.

Here are the main conditions that might require this surgery:

• Adrenal tumors: Both cancerous (adrenocortical carcinoma) and benign tumors (adenomas) that produce excess hormones
• Pheochromocytoma: Tumors that release too much adrenaline, causing dangerous blood pressure spikes
• Cushing's syndrome: When your adrenals produce too much cortisol, leading to weight gain, high blood pressure, and diabetes
• Conn's syndrome: Overproduction of aldosterone causing severe high blood pressure and low potassium
• Adrenal metastases: When cancer from other parts of your body spreads to the adrenal glands

Less commonly, some people need bilateral adrenalectomy for severe Cushing's disease when other treatments have failed. Your doctor will carefully weigh the benefits against the risks before recommending this major step.

What is the procedure for adrenalectomy?

Your surgeon can perform adrenalectomy using different approaches, with laparoscopic (minimally invasive) surgery being the most common method today. The choice depends on the size and location of your tumor, your overall health, and your surgeon's expertise.

Here's what typically happens during the procedure:

1. Anesthesia: You'll receive general anesthesia so you're completely asleep during surgery
2. Positioning: Your surgeon will position you on your side or face-down to access the adrenal glands
3. Incision: Small incisions (laparoscopic) or one larger incision (open surgery) will be made
4. Gland removal: Your surgeon carefully separates the adrenal gland from surrounding tissues and blood vessels
5. Closure: The incisions are closed with sutures or surgical glue

Laparoscopic surgery uses 3-4 small incisions and a tiny camera, resulting in less pain and faster recovery. Open surgery requires a larger incision but may be necessary for very large tumors or when cancer is suspected.

The entire procedure typically takes 1-4 hours, depending on the complexity of your case and whether one or both glands need removal.

How to prepare for your adrenalectomy?

Preparing for adrenalectomy involves several important steps to ensure your surgery goes smoothly and safely. Your healthcare team will guide you through each step, but here's what you can generally expect in the weeks leading up to your procedure.

Your preparation will likely include these key steps:

• Pre-operative testing: Blood tests, imaging scans, and heart function tests to assess your overall health
• Medication adjustments: Your doctor may prescribe medications to control blood pressure or hormone levels before surgery
• Hormone replacement planning: If both glands are being removed, you'll start learning about lifelong hormone replacement therapy
• Dietary guidelines: You'll need to fast for 8-12 hours before surgery
• Medication review: Some medications, especially blood thinners, may need to be stopped temporarily

If you have a pheochromocytoma, your doctor will prescribe special medications called alpha-blockers for several weeks before surgery. These help prevent dangerous blood pressure spikes during the procedure.

Make sure to arrange for someone to drive you home and stay with you for the first day or two after surgery. Having support during your recovery makes a significant difference in your comfort and safety.

How is recovery after adrenalectomy?

Recovery from adrenalectomy varies depending on whether you had laparoscopic or open surgery, but most people do remarkably well with proper care and patience. Your body needs time to heal from the surgery and adjust to any hormonal changes.

Here's what you can expect during your recovery:

• Hospital stay: 1-2 days for laparoscopic surgery, 3-5 days for open surgery
• Pain management: Prescription pain medications for the first week, then over-the-counter options
• Activity restrictions: No heavy lifting (over 10 pounds) for 2-4 weeks
• Return to work: 1-2 weeks for desk jobs, 4-6 weeks for physical jobs
• Full recovery: Most people feel completely normal within 6-8 weeks

If you had both adrenal glands removed, you'll need to start hormone replacement therapy immediately. This involves taking daily medications to replace the hormones your adrenal glands normally produce.

Your surgical team will provide detailed instructions about wound care, when to resume normal activities, and warning signs to watch for. Following these guidelines carefully helps ensure the best possible outcome.

What are the risks and complications of adrenalectomy?

Like any major surgery, adrenalectomy carries some risks, but serious complications are relatively uncommon when performed by experienced surgeons. Understanding these risks helps you make informed decisions about your care and know what to watch for during recovery.

Common risks that can occur with any surgery include:

• Bleeding: Though rare, significant bleeding may require blood transfusion
• Infection: Surgical site infections occur in less than 5% of cases
• Blood clots: Risk is minimized with early movement and blood thinners if needed
• Anesthesia reactions: Rare but can include breathing difficulties or allergic reactions

Specific risks related to adrenalectomy include damage to nearby organs like the kidney, liver, or spleen. Your surgeon takes great care to protect these structures, but the risk exists due to the adrenal glands' location.

If you have bilateral adrenalectomy, you'll develop a condition called adrenal insufficiency, which requires lifelong hormone replacement therapy. While this sounds scary, many people live completely normal lives with proper medication management.

When should I see a doctor after adrenalectomy?

You should contact your healthcare team immediately if you experience any concerning symptoms after your adrenalectomy. While most people recover smoothly, knowing when to seek help can prevent minor issues from becoming serious problems.

Call your doctor right away if you notice:

• Signs of infection: Fever over 101°F, increasing redness or warmth around incisions, or pus drainage
• Severe pain: Pain that gets worse instead of better, or isn't controlled by prescribed medications
• Breathing problems: Shortness of breath, chest pain, or persistent cough
• Digestive issues: Persistent nausea, vomiting, or inability to keep fluids down
• Adrenal crisis symptoms: Severe weakness, dizziness, confusion, or fainting (especially if both glands were removed)

You'll have scheduled follow-up appointments to monitor your healing and hormone levels. These appointments are crucial for ensuring your recovery stays on track and adjusting any medications if needed.

If you had bilateral adrenalectomy, you'll need regular monitoring for the rest of your life to ensure your hormone replacement therapy is working properly.